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Visarpa Chikitsa (view source)

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<big>'''Abstract </big>'''

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This chapter deals with detailed description of etiopathogenesis, classification and management principles of ''visarpa''. This is acute disease with a quick spread involving mainly skin, blood, lymph and muscle tissue due to vitiation of all three ''dosha''. Disease is clinically presented in three pathways viz. external, internal and both. Based on the involvement of dominant ''dosha'', it is classified into seven types. Prognosis and treatment duration of disease is proportionate to degree of involvement of ''dosha'' and affected internal organs. As the basic nature of disease is ''rakta'' and ''pitta'' dominant, management is focused on body purification treatments especially therapeutic purgation, blood letting, fasting therapy, medicated ghee, use of bitter drugs and various external applications having soothing and cooling effect. Guidelines for external application in the form of ''pralepa, pradeha'' and ''alepa'' are enlisted in the chapter. Blood letting is emphasized as most important treatment in ''visarpa''.

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This chapter deals with detailed description of etiopathogenesis, classification and management principles of ''visarpa''. This is acute disease with a quick spread involving mainly skin, blood, lymph and muscle tissue due to vitiation of all three [[dosha]]. Disease is clinically presented in three pathways viz. external, internal and both. Based on the involvement of dominant [[dosha]], it is classified into seven types. Prognosis and treatment duration of disease is proportionate to degree of involvement of [[dosha]] and affected internal organs. As the basic nature of disease is [[rakta]] and [[pitta]] dominant, management is focused on body purification treatments especially therapeutic purgation, blood letting, fasting therapy, medicated ghee, use of bitter drugs and various external applications having soothing and cooling effect. Guidelines for external application in the form of ''pralepa, pradeha'' and ''alepa'' are enlisted in the chapter. Blood letting is emphasized as most important treatment in ''visarpa''.

'''Keywords''': ''Visarpa, Parisarpa,'' Erysepalas, Gangrene, Septicaemia, Sepsis, Fulminant spreading skin infections.

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== Introduction ==

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The twenty first chapter is named [[Visarpa Chikitsa]]. The term ''visarpa'' has two parts viz., ''vi'' and ''sarpa''- ''vi'' stands for ''vividha'' meaning ‘various’ (ways) and ''sarpa'' stands for ''sarpan'' means ‘spreading’. Erythematous, pustular, glandular etc. lesions which spread rapidly in localized or generalized pattern are known as ''visarpa'' [ Cha.Sa. [[Chikitsa Sthana]] 21/11, Chakrapani]. This aliment is also called ''parisarpa''. The prefix ''pari'' stands for ''paritah'' or ''sarvatah'' meaning all over. The disease which spreads all over the body is called ''visarpa''. [Cha. Sa.[[ Chikitsa Sthana]] 21/11, Chakrapani]. This indicates that ''visarpa'' is an umbrella term used for acute spreading disorders caused due to vitiation of ''rakta''.

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The twenty first chapter is named [[Visarpa Chikitsa]]. The term ''visarpa'' has two parts viz., ''vi'' and ''sarpa''- ''vi'' stands for ''vividha'' meaning ‘various’ (ways) and ''sarpa'' stands for ''sarpan'' means ‘spreading’. Erythematous, pustular, glandular etc. lesions which spread rapidly in localized or generalized pattern are known as ''visarpa'' [ Cha.Sa. [[Chikitsa Sthana]] 21/11, Chakrapani]. This aliment is also called ''parisarpa''. The prefix ''pari'' stands for ''paritah'' or ''sarvatah'' meaning all over. The disease which spreads all over the body is called ''visarpa''. [Cha. Sa.[[ Chikitsa Sthana]] 21/11, Chakrapani]. This indicates that ''visarpa'' is an umbrella term used for acute spreading disorders caused due to vitiation of [[rakta]].

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In this chapter Atreya answers the queries about ''visarpa'' derivation, synonyms, classification, ''dosha, dushya,'' etiology, habitat, gradation, symptoms, complications, prognosis and treatment of curable ones. The chapter follows that of[ Cha. Sa. [[Chhardi Chikitsa]] ] because suppression of ''chhardi'' (vomiting) causes ''rakta dushti'' (vitiation of blood) leading to ''visarpa'' indicating that ''rakta'' (blood) vitiating factors and vitiation of ''rakta'' is an important basic underlying phenomenon prior to the ''visarpa''.

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In this chapter Atreya answers the queries about ''visarpa'' derivation, synonyms, classification, [[dosha]], dushya,'' etiology, habitat, gradation, symptoms, complications, prognosis and treatment of curable ones. The chapter follows that of[ Cha. Sa. [[Chhardi Chikitsa]] ] because suppression of ''chhardi'' (vomiting) causes [[rakta]] dushti(vitiation of blood) leading to ''visarpa'' indicating that [[rakta]] (blood) vitiating factors and vitiation of [[rakta]] is an important basic underlying phenomenon prior to the ''visarpa''.

''Visarpa'' is acute, spreading and fatal in nature leading to death if not treated promptly. On location basis this is classified into ''bahih-shrita'' (externally situated), ''antah-shrita'' (internally situated) and ''ubhayasam shrita'' (all over situated). ''Bahih-shrita visarpa'' is fulminant, spreading skin and flesh infection with symptoms and signs of inflammatory edema, blisters, ulcers, fever, pain etc. and is curable. ''Antah-shrita visarpa'' involves internal vital organs with mild septicaemia and is curable before complications. ''Ubhayasamshrita visarpa'' has advanced manifestations of both types spreading all over body with severe septicaemia and is fatal.

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''Visarpa'' never occurs without association of ''rakta'' and ''pitta'', hence general treatment of ''visarpa'' is described by considering ''rakta'' and ''pitta'' vitiation. Specific treatments are described by considering particular ''dosha'' involvement.

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''Visarpa'' never occurs without association of [[rakta]] and [[pitta]], hence general treatment of ''visarpa'' is described by considering [[rakta]] and [[pitta]] vitiation. Specific treatments are described by considering particular [[dosha]] involvement.

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Various etiological factors of ''visarpa'' are diet, life style, injury, poison, toxin, burn etc. vitiates ''rakta'' as well as ''dosha'' (''vata, pitta'' and ''kapha'') and other ''dhatu'' (body elements) leading to fulminant disease requiring urgent medical care.

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Various etiological factors of ''visarpa'' are diet, life style, injury, poison, toxin, burn etc. vitiates [[rakta]] as well as [[dosha]] ([[vata]], [[pitta]] and [[kapha]]) and other [[dhatu]] (body elements) leading to fulminant disease requiring urgent medical care.

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Seven components are involved in the pathogenesis of ''visarpa'' viz., ''rakta'' (blood), ''lasika'' (lymph), ''tvak'' (skin), ''mamsa'' (flesh), ''vata, pitta'' and ''kapha''. Same components are associated with ''kushtha'' (various skin disorders) but clinical presentation of both the diseases is different because etiological factors act different. As ''kushtha'' is chronic in nature and ''visarpa'' is acute in nature[Cha. Sa. [[Chikitsa Sthana]] 21/15,Chakrapani] therefore spreading ''kushtha'' should not be interpreted as ''visarpa''.

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Seven components are involved in the pathogenesis of ''visarpa'' viz., [[rakta]] (blood), ''lasika'' (lymph), ''tvak'' (skin), [[mamsa dhatu]] (flesh), [[vata]], [[pitta'' and ''kapha''. Same components are associated with ''kushtha'' (various skin disorders) but clinical presentation of both the diseases is different because etiological factors act different. As ''kushtha'' is chronic in nature and ''visarpa'' is acute in nature[Cha. Sa. [[Chikitsa Sthana]] 21/15,Chakrapani] therefore spreading ''kushtha'' should not be interpreted as ''visarpa''.

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It is also classified into ''vatika, paittika, slaishmika, agni visarpa, kardam visarpa, granthi visarpa'' and ''sannipatik'' on ''dosha'' basis. ''Bahih-shrita visarpa'' involves exterior part i.e. Skin, flesh, etc. of the body having symptoms like inflammatory oedema, blisters, ulcers, fever, pain etc. and is curable. ''Agni visarpa'' and ''kardam visarpa'' may be cured with appropriate timely management otherwise negligence leads to death of the patient. ''Granthi visarpa'' should be treated before complications otherwise it becomes incurable. ''Sannipatika visarpa'' is a severe manifestation of the disease leading to death.[Cha. Sa. [[Chikitsa Sthana]] 21/42]

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It is also classified into ''vatika, paittika, slaishmika, agni visarpa, kardam visarpa, granthi visarpa'' and ''sannipatik'' on [[dosha]] basis. ''Bahih-shrita visarpa'' involves exterior part i.e. Skin, flesh, etc. of the body having symptoms like inflammatory oedema, blisters, ulcers, fever, pain etc. and is curable. ''Agni visarpa'' and ''kardam visarpa'' may be cured with appropriate timely management otherwise negligence leads to death of the patient. ''Granthi visarpa'' should be treated before complications otherwise it becomes incurable. ''Sannipatika visarpa'' is a severe manifestation of the disease leading to death.[Cha. Sa. [[Chikitsa Sthana]] 21/42]

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In ''visarpa, shodhana'' therapy has given prime importance because ''rakta kleda'' (putrificatory ingredient) and ''dosha'' vitiation is at higher level hence ''samana'' (pacification) therapy is not very effective. ''Visarpa'' never occurs without association of ''rakta'' and ''pitta''. Hence general treatment of ''visarpa'' is described by considering ''rakta'' and ''pitta'' vitiation. Specific treatments are described as per the involvement of ''dosha''. Single ''raktamokshana'' (blood letting) treatment is equal to all of other treatments described for ''visarpa''. [Cha. Sa. [[Chikitsa Sthana]] 21/141-143].

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In ''visarpa, shodhana'' therapy has given prime importance because ''rakta kleda'' (putrificatory ingredient) and [[dosha]] vitiation is at higher level hence ''samana'' (pacification) therapy is not very effective. ''Visarpa'' never occurs without association of [[rakta]] and [[pitta]]. Hence general treatment of ''visarpa'' is described by considering [[rakta]] and [[pitta]] vitiation. Specific treatments are described as per the involvement of [[dosha]]. Single ''raktamokshana'' (blood letting) treatment is equal to all of other treatments described for ''visarpa''. [Cha. Sa. [[Chikitsa Sthana]] 21/141-143].

''Kshataja visarpa'' is another variety mentioned additionally in Sushruta Samhita. The later texts followed the same description with addition of some medications.

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</div></div>

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''Visarpa'' is of seven types as per ''dosha'' basis and it involves seven body elements.

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''Visarpa'' is of seven types as per [[dosha]] basis and it involves seven body elements.

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Three types of ''visarpa'' are due to the morbidity of individual ''dosha''; one variety is due to the morbidity of all the three ''dosha'' and three varieties are due to the morbidity of any of the two ''dosha''.

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Three types of ''visarpa'' are due to the morbidity of individual [[dosha]]; one variety is due to the morbidity of all the three [[dosha]] and three varieties are due to the morbidity of any of the two [[dosha]].

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''Vatika, paittika, kaphaja'' and ''sannipatik'' these are the four varieties of ''visarpa'' and the remaining three varieties viz., ''vata-~~pittaja~~, kapha-~~vataja''~~ and ''pitta-~~kaphaja''~~ type will now be described.

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''Vatika, paittika, kaphaja'' and ''sannipatik'' these are the four varieties of ''visarpa'' and the remaining three varieties viz., [[vata]]-[[pitta]]ja, [[kapha]]-[[vata]]ja and [[pitta]]-[[kapha]]ja type will now be described.

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The variety due to morbid ''vata-pitta'' is ''agnivisarpa, kapha-vata'' cause ''granthi visarpa'' and ''pitta-kapha'' leads to serious condition known as ''kardamaka visarpa''. [12-14]

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The variety due to morbid [[vata]]-[[pitta]] is agnivisarpa, [[kapha]]-[[vata]] cause ''granthi visarpa'' and [[pitta]]-[[kapha]] leads to serious condition known as ''kardamaka visarpa''. [12-14]

=== Vitiated factors ===

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</div></div>

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Blood, lymph, skin, flesh and three ''dosha'', these seven elements are involved in the pathogenesis of ''visarpa'' of all kinds. [15]

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Blood, lymph, skin, flesh and three [[dosha]], these seven elements are involved in the pathogenesis of ''visarpa'' of all kinds. [15]

=== Etiology ===

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Excessive indulgence in ''lavana'' (salt), ''amla'' (sour), ''katu'' (pungent) and ''ushna'' (hot ingredients); as also in ''amla dadhi'' (sour curd), ''dadhi mastu'' (whey), ''shukta'' (vinegars), ''sura'' (type of liquor) and ''sauviraka'' (type of wine); the use of ''vyapanna madya'' (contaminated wine) or excessive liquor or heat inducing ''raga'' (condiments) and ''sadava'' (confectionery), the use of ''vidahi'' (causes burning), ''shaka'' (vegetables) and ''harita'' (''lashunadi harita'' group ''dravya''), ''kilata'' (cheese), ''kurchika'' (inspissated milk) and ''mandaka'' (immature curd), the use of ''sandaki'' (fermented wine), as also of ''paistika'' (one made up of ''pistamai padarth'' or pastries) and oils made of sesame, black gram and horse gram, the use of flesh of domesticated, wet land and aquatic animals and garlic, the use of the ''praklinna'' (putrified food), ''asatmya'' (unwholesome) and ''viruddha'' (mutually contradictory ingredients), over eating, sleeping during day time, ''ajirnashana'' (eating during indigestion), ''adhyashana'' (eating food immediately after the meal); ''kshatat'' (traumatic injury), ''kshata'' (wounds), ''bandha'' (ligatures), ''prapatana'' (trauma due to falls) over exposure to sun, strainful work, poisons, poisonous air,burns etc.

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By combination of above mentioned etiological factors, the provoked ~~''vatadi~~ dosha'' affect the susceptible body elements such as ''rakta, lasika'' etc. and spread in the body in those indulged in unwholesome diet. [16-22]

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By combination of above mentioned etiological factors, the provoked [[vata]]di [[dosha]] affect the susceptible body elements such as [[rakta]], lasika etc. and spread in the body in those indulged in unwholesome diet. [16-22]

=== Pathways of spreading the disease ===

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</div></div>

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Externally situated (pathogenesis in ''shakha, rasa'' and ''rakta dhatu''), internally situated (pathogenesis in internal organs and other ''dhatu'') and situated in both (externally as well as internally) pathways ''visarpa'' is to be known more and more serious consecutively.

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Externally situated (pathogenesis in shakha, [[rasa dhatu]]and [[rakta dhatu]]), internally situated (pathogenesis in internal organs and other [[dhatu]]) and situated in both (externally as well as internally) pathways ''visarpa'' is to be known more and more serious consecutively.

Externally situated ''visarpa'' is curable, internally situated ''visarpa'' is very serious and difficult to cure whereas externally as well as internally situated type is incurable.

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''Visarpa'' manifesting with all signs and symptoms, having strong etiological factors, which is associated with formidable complications and that situates as well as affects vital parts, proves fatal.[28]

</div>

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=== Etio-pathogeneis and clinical features of ''vata'' dominant ''visarpa'' ===

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=== Etio-pathogeneis and clinical features of [[vata]] dominant ''visarpa'' ===

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</div></div>

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''Vayu'' aggravated by ununctuous and hot ingredients or by the obstruction due to vitiated ''dosha'', impairs the body elements and spreads in proportion to its strength.

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[[Vayu]] aggravated by ununctuous and hot ingredients or by the obstruction due to vitiated [[dosha]], impairs the body elements and spreads in proportion to its strength.

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Its signs and symptoms are giddiness, burning sensation, excessive thirst, pricking sensation, severe pain, body ache, cramps, shivering, fever, feeling of entering in darkness, cough, breaking and splitting pains in the bones and joints, looseness in joints, trembling, anorexia, indigestion, congestion of the eyes, lacrimation and paresthesia; the region where the inflammation is spreading becomes blackish and reddish in color and edematous. The patient suffers from severe pricking, splitting or aching pain in the part affected as also extension and contractions of the parts, horripilation and quivering. If not treated it gives rise to quick bursting small blackish or reddish blisters with thin clear reddish and scanty discharge. The patient also suffers from the retention of flatus, urine and feces. Etiological factors do not suit and the contrary ones suit the patient, this is ''vata'' dominant ''visarpa''. [29-30]

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Its signs and symptoms are giddiness, burning sensation, excessive thirst, pricking sensation, severe pain, body ache, cramps, shivering, fever, feeling of entering in darkness, cough, breaking and splitting pains in the bones and joints, looseness in joints, trembling, anorexia, indigestion, congestion of the eyes, lacrimation and paresthesia; the region where the inflammation is spreading becomes blackish and reddish in color and edematous. The patient suffers from severe pricking, splitting or aching pain in the part affected as also extension and contractions of the parts, horripilation and quivering. If not treated it gives rise to quick bursting small blackish or reddish blisters with thin clear reddish and scanty discharge. The patient also suffers from the retention of flatus, urine and feces. Etiological factors do not suit and the contrary ones suit the patient, this is [[vata]] dominant ''visarpa''. [29-30]

</div>

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=== Etio-pathogeneis and clinical features of ''pitta'' dominant ''visarpa'' ===

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=== Etio-pathogeneis and clinical features of [[pitta]] dominant ''visarpa'' ===

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</div></div>

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The ''pitta'' aggravated by the use of hot regimen, by eating irritant and sour foods vitiates the susceptible body elements and by feeling the vessels, begins to spread.

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The [[pitta]] aggravated by the use of hot regimen, by eating irritant and sour foods vitiates the susceptible body elements and by feeling the vessels, begins to spread.

Its signs and symptoms are fever, morbid thirst, fainting, disturbed consciousness, vomiting, anorexia, breaking body ache, excessive perspiration, burning, delirium, headache, congestion of the eyes, insomnia, restlessness, giddiness, excessive desire for cold air and water. Greenish or yellowish coloration of eyes, urine and feces, objects visualizes green and yellow. In the region where the ''visarpa'' spreads, becomes coppery, greenish, yellowish, bluish, blackish, reddish color. Affected part becomes excessively edematous and full of pustules, having intense burning and tearing pain, suppurating quickly and discharging fluid of similar color.

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The etiological factors do no suit and the contrary ones suit the patient. This is ''pitta'' dominant ''visarpa''. [31-32]

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The etiological factors do no suit and the contrary ones suit the patient. This is [[pitta]] dominant ''visarpa''. [31-32]

</div>

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=== Etio-pathogeneis and clinical features of ''kapha'' dominant ''visarpa'' ===

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=== Etio-pathogeneis and clinical features of [[kapha]] dominant ''visarpa'' ===

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</div></div>

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''Kapha'' excessively accumulated due to intake of sweet, sour, salt, unctuous and heavy foods, and also by excessive sleep, vitiates the susceptible body elements and spreads with slow speed in the body.

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[[Kapha]] excessively accumulated due to intake of sweet, sour, salt, unctuous and heavy foods, and also by excessive sleep, vitiates the susceptible body elements and spreads with slow speed in the body.

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Its signs and symptoms are chills, fever with chills, heaviness, excess sleep, drowsiness, adherence of sticky material in the mouth, excess spitting, vomiting, lassitude, timidity, loss of appetite and prostration. The region where the disease spreads becomes edematous, pallor or slight red, unctuous, numbness, rigidness, heaviness and slight pain. It suppurates hardly and chronic in nature. It is studded with eruptions which are covered with a thick skin and having white pale color. When burst, they discharge white, slimy, fibrinous, dense, sticky and viscid discharge from it. Thereafter it is followed by the ulcers which are heavy, deep seated, surrounded by capillary network, unctuous and covered with many skin scabs. These ulcers are chronic in nature. The nails, eyes, face, skin, urine and faces of the patient appear pale. The etiological factors do no suit and the contrary ones suit the patient. This is ~~''kaphaja~~ visarpa''. [33-34]

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Its signs and symptoms are chills, fever with chills, heaviness, excess sleep, drowsiness, adherence of sticky material in the mouth, excess spitting, vomiting, lassitude, timidity, loss of appetite and prostration. The region where the disease spreads becomes edematous, pallor or slight red, unctuous, numbness, rigidness, heaviness and slight pain. It suppurates hardly and chronic in nature. It is studded with eruptions which are covered with a thick skin and having white pale color. When burst, they discharge white, slimy, fibrinous, dense, sticky and viscid discharge from it. Thereafter it is followed by the ulcers which are heavy, deep seated, surrounded by capillary network, unctuous and covered with many skin scabs. These ulcers are chronic in nature. The nails, eyes, face, skin, urine and faces of the patient appear pale. The etiological factors do no suit and the contrary ones suit the patient. This is [[kapha]]ja visarpa''. [33-34]

</div>

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=== Etio-pathogenesis and clinical features of ''vata-pitta'' dominant ''agni visarpa'' ===

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=== Etio-pathogenesis and clinical features of [[vata]]-[[pitta]] dominant ''agni visarpa'' ===

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When ''vata-pitta'' vitiated severely due to their respective etiological factors and strengthened mutually, spreads producing severe burning pain in the body.

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The patient affected with this type of ''visarpa'' feels as if his body is sprinkled with flaming coals. He suffers from vomiting, diarrhea, fainting, burning sensation, disturbed consciousness, fever, feeling of darkness, anorexia, breaking pain in bones and joints, morbid thirst, indigestion, breaking body pain etc. The part where the disease spreads looks like extinguished charcoal or blood like red, affected region gets covered with blisters like those caused by burns. Due to its rapid progress, it soon spreads to vital regions. When the vital parts gets affected, the ''vata'' which is excessively aggravated causes extensive disintegration of the tissues and leads to disturbed consciousness, produces hiccup, dyspnea and insomnia. That sleepless patient with disturbed consciousness and miserable mind does not get relief anywhere. He becomes restless in standing, seating and desires to lie on bed, thus exceedingly exhausted due to pain soon falls into deep sleep. Being debilitated, he is aroused from this state with difficulty. One suffering from ''agni-visarpa'' is to be regarded as incurable.[35-36]

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The patient affected with this type of ''visarpa'' feels as if his body is sprinkled with flaming coals. He suffers from vomiting, diarrhea, fainting, burning sensation, disturbed consciousness, fever, feeling of darkness, anorexia, breaking pain in bones and joints, morbid thirst, indigestion, breaking body pain etc. The part where the disease spreads looks like extinguished charcoal or blood like red, affected region gets covered with blisters like those caused by burns. Due to its rapid progress, it soon spreads to vital regions. When the vital parts gets affected, the [[vata]] which is excessively aggravated causes extensive disintegration of the tissues and leads to disturbed consciousness, produces hiccup, dyspnea and insomnia. That sleepless patient with disturbed consciousness and miserable mind does not get relief anywhere. He becomes restless in standing, seating and desires to lie on bed, thus exceedingly exhausted due to pain soon falls into deep sleep. Being debilitated, he is aroused from this state with difficulty. One suffering from ''agni-visarpa'' is to be regarded as incurable.[35-36]

</div>

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=== Etio-pathogenesis and clinical features of ''kapha-pitta'' dominant ''kardam visarpa'' ===

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=== Etio-pathogenesis and clinical features of [[kapha]]-[[pitta]] dominant ''kardam visarpa'' ===

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</div></div>

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Excessively aggravated ''kapha pitta'' due to their respective etiological factors, spreads in the body causing suppuration of the tissues in particular part.

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Excessively aggravated [[kapha]] [[pitta]] due to their respective etiological factors, spreads in the body causing suppuration of the tissues in particular part.

Its signs and symptoms are fever with chills, heaviness of the head, burning sensation, timidity, prostration, excessive sleep, drowsiness, disturbed consciousness, food dislike, delirium, loss of appetite, weakness, breaking pain in bones, fainting, morbid thirst, adhesions of sticky material in channels, dullness of the senses, mostly seating, abnormal movements of limbs, body pain, restlessness, anxiety, often it spreads to ''amashaya''. It is localized and spreads with slow speed.

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The part where the disease spreads looks as if filled with reddish, yellowish, pale eruptions. The affected part becomes muddy, black, dirty, unctuous, excess hot, heavy, dull aching, edematous, with deep seated suppuration, having no discharge, rapidly become sloughy, sweated suppurated, having putrid flesh and skin, gradual little pain, when touched bursts and gives space on pressing, throws out decomposed and putrefied flesh, shows blood vessels, ligaments and has cadaverous smell and causes disturbed consciousness as well as memory. This is called ''kardam visarpa'' and is incurable. [37-38]

</div>

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=== Etio-pathogenesis and clinical features of ''kapha vata'' dominant ''granthi visarpa'' ===

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=== Etio-pathogenesis and clinical features of [[kapha]] [[vata]] dominant ''granthi visarpa'' ===

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</div></div>

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Among all types of ''visarpa vatik'', ''paittik'' and ''kaphaja'' these three are curable. ''Agni'' and ''kardam visarpa'' not spreading to vital organs and causing no suppuration of the vessels, ligaments and muscles can be pacified by the general treatment of ''visarpa''. When managed with negligence both may cause death of patients like snake venom. ''Granthi visarpa'' should be treated before complications has arisen, otherwise should be rejected. ''Sannipataja visarpa'' should be taken as incurable because of it is spreading to all ~~''dhatus''~~, very fulminant and refractory to treatment.[42]

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Among all types of ''visarpa vatik'', ''paittik'' and ''kaphaja'' these three are curable. ''Agni'' and ''kardam visarpa'' not spreading to vital organs and causing no suppuration of the vessels, ligaments and muscles can be pacified by the general treatment of ''visarpa''. When managed with negligence both may cause death of patients like snake venom. ''Granthi visarpa'' should be treated before complications has arisen, otherwise should be rejected. ''Sannipataja visarpa'' should be taken as incurable because of it is spreading to all [[dhatu]], very fulminant and refractory to treatment.[42]

=== Principles of treatment ===

Anaghas

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Visarpa Chikitsa (view source)

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